UCLA

Unhealthy alcohol use, alcohol use that increases the risk of negative health and life consequences, is one of the leading preventable causes of morbidity and mortality in the United States, but treatment is often underutilized or delayed. In three studies, this dissertation applies the Multi-Level Health Outcomes Framework to explore patient, provider, and system-level factors related to receipt of treatment for unhealthy alcohol use.

The first study examined data from a population-based survey and applied weighted logistic regression to assess the relationship between patient characteristics and receipt of help among individuals regularly engaging in unhealthy alcohol use. Individuals from certain racial/ethnic minority groups were less likely to receive help, while findings suggested higher likelihood of receipt of help among those with Medicaid insurance, higher education, and higher severity alcohol use. Knowledge of the factors associated with receipt of help for alcohol use can inform targeted interventions to increase treatment receipt.

The second study utilized survey and Medicaid claims data from an evaluation of the Public Hospital Redesign and Incentives in Medi-Cal (PRIME) program to assess the relationship between behavioral health integration (BHI) and alcohol-related outcomes among primary care patients with alcohol-related diagnoses in 17 designated public hospitals in California. Using multilevel logistic regression, no significant associations were observed between overall BHI and main outcomes, but associations emerged between subcomponents of BHI and receipt of alcohol-related care. Findings warrant further research into relationships between specific components of BHI and receipt of care for alcohol use.

The third study applied template and content analysis to assess data from narrative reports completed by hospital leadership over a five-year period obtained from an evaluation of the PRIME program to assess implementation of screening, brief intervention, and referral to treatment (SBIRT) for alcohol and substance use among primary care patients receiving care from 22 public hospitals in California. Findings highlighted wide variation in SBIRT processes and aspects of planning, education, and restructuring particularly influential in driving progress in implementing SBIRT.

Collectively, this dissertation highlights factors influencing receipt and provision of care to inform efforts to promote earlier identification and treatment of unhealthy alcohol use.